Association of Mycoplasma genitalium with acute non-gonococcal urethritis in Russian men: a comparison with gonococcal and chlamydial urethritis.

Urethral specimens from 172 men who attended sexually transmitted disease clinics in the Moscow Oblast were examined for Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium by nucleic acid amplification tests. N. gonorrhoeae was detected in the urethra of 41 (24%) of the 172 men and C. trachomatis in 57 (33%). The latter occurred in 15 (36%) of the 41 men who were infected by N. gonorrhoeae and in 42 (32%) of 131 uninfected by gonococci. Of the 42 men uninfected by gonococci but chlamydia infected, 39 (93%) had symptoms and/or signs of urethritis. M. genitalium was detected in 45 (26%) of the 172 men, in nine (22%) of the 41 men infected with N. gonorrhoeae and in 12 (21%) infected with C. trachomatis. M. genitalium was detected alone in 25 (28%) of the 89 men uninfected by either gonococci or C. trachomatis. Of these 25 men, 24 (96%) had urethral symptoms and signs of inflammation, a proportion significantly more than experienced by the 64 men uninfected by any of the microorganisms. Of the 31 men who apparently had no symptoms or signs of urethritis, only three (10%) were infected by M. genitalium. The data provide evidence for the pathogenicity and frequent occurrence of M. genitalium in men in Moscow and presumably elsewhere in Russia.

A trial of the validity of genital smears and cultures with gonococcal vaccine provocation in diagnosing genital gonorrhoea in women.

In Russia the diagnosis of gonorrhoea in women relied on microscopy, justified by the hypothesis that sensitivity increases using 'provocation' techniques. The aim was to test the value of Gonovaccine as provocation in women who would have received it normally. Cervical specimens from 204 women were tested by culture and a ligase chain reaction (LCR) assay before the women were randomized to receive provocation or not. Further cervical specimens were obtained 24, 48 and 72 hours later for microscopy, culture and LCR tests. In both provocation and non-provocation arms, 24 women were positive for gonorrhoea by the LCR assay. Test-by-test, sensitivity of microscopy was 30% in the provocation arm and 13% in the control arm (P = 0.0407, Fisher's exact test). Patient-by-patient, sensitivity of microscopy was 50% in the provocation arm, but only 25% in the control arm (P = 0.0675, Fisher's exact test). The cost per case was greater ($214) using provocation with microscopy than culture and microscopy at the first visit ($150). Thus, although Gonovaccine provocation doubled the sensitivity of microscopy in detecting gonococci, the internationally recommended protocol of microscopy and culture at first visit should be adopted as routine practice in Russia. The findings raise questions about the pathogenesis and natural history of gonorrhoea.

Performance of direct fluorescent antibody tests for routine diagnosis of Chlamydia trachomatis in Russian sexually transmitted disease clinics.

SUMMARY: Testing for Chlamydia trachomatis in Russia is usually done by microscopic examination of genital smears stained with fluorescent antibody provided in locally produced kits. The aim was to assess the sensitivity and specificity of such direct fluorescent antibody (DFA) tests compared with a nucleic acid amplification test (NAAT) (ligase chain reaction) to detect C. trachomatis in 171 cervical smears and 201 urethral smears from men. The patients were at high risk of chlamydial infection and had been recruited at three sexually transmitted disease clinics in Moscow. Among women, DFA test sensitivity was 6% (95% CI 0-14) and the specificity was 92% (95% CI 88-97). Among men, the sensitivity was 9% (95% CI 2-16) and the specificity was 90% (95% CI 83-94). Poor DFA test performance was probably due to poor antibody quality and such tests are not adequate for routine examination of populations with either low or high chlamydial prevalence. As there may remain a place for DFA testing where few patients are seen, the Russian Ministry of Health should enforce registration of diagnostic tests, and Russian manufacturers should seek ways of improving DFA test performance. However, the mainstay of testing should depend on NAATs.

[Syphilis as a chronic systemic infection].

During the last STDs'epidemic in Russia (1994 - 2004) over 2.7 min people have been infected with syphilis. At present the structure of syphilis morbidity is characterized by 37% of latent forms, including 1.5% late latency. The increased level of late latency may result from: an ever-growing number of those with asymptomatic syphilis; disorderly and self-dependent usage of antibacterial preparations; spread of the virus chronic infections (herpes, hepatitis B, C) altering the macroorganism immune response; alcohol and drug abuse which decreases the efficacy of specific therapy. In general, chronization of the syphilitic infection may be caused by antigenically inert treponemal cell surface; paucity of outer membrane protein; residence of treponemas within an immunoprotective niche; uncompleted phagocytosis of treponemes with macrophages. Syphilis remains an "infectio magna" and demands thorough attention to all diagnostic and therapeutic procedures on every stage of the disease.

Chlamydia trachomatis infections in eastern Europe: legal aspects, epidemiology, diagnosis, and treatment.

OBJECTIVES: Knowledge concerning genital Chlamydia trachomatis infections in eastern Europe is scarce. Data on the legal aspects, epidemiology, diagnosis, and treatment of the infection have never been collected, summarised, and presented to the international scientific community. The aim of this study was to present the current situation on the main aspects of chlamydial infections in the countries of eastern Europe. METHODS: Written questionnaires concerning legal aspects, epidemiology, diagnosis, and treatment of the infection were distributed among national STI operating administrators as well as researchers who had presented papers at earlier meetings of European chlamydia or STI societies. RESULTS: Most of the countries have not legalised reporting of chlamydial infections and in those who have done so, the quality of the reporting system is poor. Contact tracing is mostly done on a voluntary basis. Reported chlamydia incidence varies from 21 to 276 per 100000 inhabitants. The most commonly used diagnostic test remains the direct immunofluorescence test; however, some tendencies towards nucleic acid amplification are in evidence. Diagnostic services are paid for by the patient himself, while treatment in many countries is partially or completely covered by public insurance. CONCLUSIONS: This is the first report summarising data concerning the situation on C trachomatis infections in eastern Europe. The reporting system and diagnosis of C trachomatis infections remain suboptimal, which allows neither control of the epidemiological situation nor optimal treatment of the patients. The most urgent work currently necessary is the education of professionals and the general population.

The control and management of the sexually transmitted diseases: a comparison of the United Kingdom and the Russian Federation.

During the last 20 years, both the United Kingdom and the Russian Federation have seen changes to clinical services for sexually transmitted diseases (STDs) health systems and other mechanisms through which STDs are controlled. In the UK these changes followed the description of the acquired immunodeficiency syndrome (AIDS) and the human immunodeficiency virus (HIV); its causal agent. In Russia, the breakdown of the Soviet Union following glasnost and perestroika, and its associated political, social and economic changes generated substantial developments to the ideological and legislative framework within which STD control is achieved as well as a revolution in the financial base upon which clinical STD services operate. The purpose of this paper is to sketch these developments in STD services within the 2 countries to provide a context for the series of papers presented in this edition.

PIP: This paper examines developments in the control and management of sexually transmitted diseases (STDs) in the United Kingdom and the Russian Federation. There have been substantial changes in the clinical services for STD health systems and other mechanisms through which the disease is controlled. In England and Wales, these clinical services have been dictated by the public health response to AIDS and HIV, both in terms of control, and resources for innovation and development. The principles of voluntary, open and confidential services have been maintained within genitourinary medicine. Furthermore, services have become more patient-focused and the role of non-statutory organizations and patients in service, and intervention development has grown. In Russia, since glasnost and perestroika, there has been considerable progress in a similar direction with increasing levels of confidentiality, greater coordination of services, and the development of activities in primary prevention at a time of economic difficulty and the outbreak of the syphilis epidemic. The key areas for development include the following: securing improvements to ethical and humane quality of clinical practice; promotion of evidenced-based; quality-controlled protocols for diagnosis; management; and balance of health promotion and clinical service provision.

Resurgence of sexually transmitted diseases in Russia and eastern Europe.

The reasons for the outbreak of syphilis and other STDs in the former USSR are investigated in this article. The most important of those are of socioeconomic, biomedical, and organizational origin. The dramatic changes in society has led to changes in the strategy of the dermatovenereologic service. The role of departments of anonymous testing and treatment in controlling the STDs epidemic is discussed. This article also contains statistical data concerning the STDs morbidity in Russia and Eastern Europe during the last years.

Syphilitic vignettes from Russia.

The data show that syphilis is widespread in the society and may be seen among every age group of population from infants to the elderly. A description of 8 unusual cases of syphilis revealed in Russia during the current epidemic of this disease is discussed, including congenital syphilis, acquired syphilis in children, and malignant syphilis in adults.

[Ciprofloxacin in the treatment of urogenital infections in women]. / Tsiprofloksatsin v lechenii urogenital'nykh infektsii zhenshchin.

The examination included 51 women. In 25.5 and 33.3 per cent of them gonorrhea and association of gonorrhea with trichomoniasis, chlamydiosis or ureaplasmosis and in 35.3 and 5.9 per cent chlamydiosis and association of chlamydiosis with trichomoniasis were stated respectively. 56.9 and 17.6 per cent of the women had the mixed infection in the urogenital tract and in extragenital foci respectively. The regimen of the chronic gonorrhea therapy included the use of ciprofloxacin in the initial dose of 500 mg and the subsequent doses of 250 mg every 12 hours, the course dose being 1.25 g. The efficacy of the treatment amounted to 100 per cent. The treatment of the patients with gonorrhea association with ureaplasmosis in a dose of 500 mg administered every 12 hours (the course dose of 5 g) resulted in eradication of ureaplasma in 71.4 per cent of the patients. The efficacy of the chlamydiosis treatment in the course dose of 10 g (500 mg every 12 hours) amounted to 88 per cent.

[The problem of diagnosis and treatment of urogenital chlamydiosis in Russia]. / Problema diagnostiki i lecheniia urogenital'nogo khlamidioza v Rossii.

The problems associated with the distribution, diagnosis, classification and treatment of urogenital tract chlamydiosis in Russia are discussed. Some arrangements for the improvement of the activities of the laboratory diagnostic services, the use of the International Classification of urogenital tract chlamydioses and the treatment optimization are offered. The drug of choice in the treatment of urogenital tract chlamydiosis is azithromycin (Sumamed, Pliva). Doxycycline, erythromycin and ofloxacin are recommended as the reserve drugs.

[A comparative study of the quantitative distribution and ultrastructure of Langerhans cells in the epidermis of patients with chronic benign dermatoses and mycosis fungoides]. / Sravnitel'naia otsenka kolichestvennogo raspredeleniia i ul'trastruktury kletok Langergansa v épidermise bol'nykh khronicheskimi dobrokachestvennymi dermatozami i gribovidnym mikozom.

Using histoenzymatic assay for ATPase activity and electron microscopy, Langerhans' cells (LC) in biopsy specimens taken from skin lesions of 20 patients with chronic benign dermatoses (CBD) and of 28 patients suffering from mycosis fungoides (MF) were identified. In the early lesions of MF the reduction of the number of cell dendrites, disappearance of normal arrangement and the reduced absolute quantity of LC were observed on comparison with patients with CBD. Ultrastructurally, the destroyed forms of LC were predominantly observed in MF lesions, while in cases of CBD most of the LC were functionally active. The authors suggest that the examination of functional activity, quantitative distribution and ultrastructural features of LC should be used as an early morphologic test for differential diagnosis of early signs of MF and CBD this being of vital importance for an adequate and due treatment.

[The mono-oxygenase enzyme system of the liver in patients with true eczema]. / Sostoianie monooksigenaznoi fermentnoi sistemy pecheni u bol'nykh istinnoi ékzemoi.

Correlations between the clinical course of true eczema and liver monooxigenase system, assessed by antipyrine test, were investigated in patients suffering from the condition. The findings evidence that antipyrine half-life period is prolonged in the patients vs. the reference subjects. Clinical status parameters were more marked and disease duration longer in the patients with a longer antipyrine half-life (over 12 hrs). A correlation between antipyrine half-life period and the disease standing was revealed.

[The effect of furanocoumarins on microsomal oxidation in the rat liver]. / Vliianie furanokumarinov na mikrosomal'noe okislenie v pecheni krys.

Puvalen and psoberan are inhibitors of monoxygenase enzyme system activity of the liver. Puvalen exerts the biphase effect on the system, so it may be referred to such classic inhibitors as SKF-525A and pyperonil butoxide. Psoberan does not exert the biphase effect on the monoxygenase system that is apparently connected with its negative action on biomembrane structure of hepatocytes. The results must be taken into consideration when patients are treated with psoralens.

[The typological characteristics of the nervous system and the autonomic tonus of patients with true eczema]. / Tipologicheskie osobennosti nervnoi sistemy i sostoianie vegetativnogo tonusa u bol'nykh istinnoi ékzemoi.

Studies of the clinical course of true eczema and of the therapy efficacy, as well as of the typologic features of the nervous system and the vegetative tone have shown that the therapy efficacy is much lower and the exacerbation of the dermatosis is longer in the subjects with a weak-type nervous system and sympatheticotonia than in those with a strong-type nervous system and vagotonia.

[Sweet's syndrome]. / Sindrom Svita.

A patient aged 50 with Sweet's syndrome combined with renal diseases is described. The clinical and pathomophological picture of the disease is described in detail. The skin process regressed after left percutaneous nephrostomy performed for the left ureter obstruction and after antibiotic and depuration therapy.